Correlation of clinical, parasitological and histopathological diagnosis of cutaneous leishmaniasis in an endemic region in Sri Lanka.

Abstract

Diagnosis of cutaneous leishmaniasis (CL) largely depends on the clinical appearance of the lesions in endemic areas. The aim of this study was to correlate the clinical diagnosis with positive laboratory tests used for the identification of leishmania parasite (stained smears and histopathology) and therapeutic response. 114 clinically suspected patients (190 lesions) were studied. They were diagnosed as typical clinical cases (87.4%) and clinically suggestive cases (12.6%) on the basis of criteria for clinical diagnosis. Slit-skin-smear and histopathology were performed in all patients. Out of 103 who were clinically diagnosed, 62 (60.2%) were confirmed parasitologically. Out of 41 who were negative for both smear and histology, 34 (33%) had supportive histology and the diagnosis was supported by good treatment response in 37 (35.9%). Hence, the clinical diagnosis was 93.2% accurate and this increased to 96% after observing the good response to therapy. Considering the magnitude of the problem, limited resources, and clinical accuracy of 96%, clinical diagnosis by a dermatologist appears to be reliable enough in diagnosing CL lesions in endemic areas in Sri Lanka.